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Open Access 01-12-2021 | Ultrasound | Original Article

Shear wave and strain sonoelastography for the evaluation of the Achilles tendon during isometric contractions

Authors: Alessandro Schneebeli, Ilaria Fiorina, Chandra Bortolotto, Marco Barbero, Deborah Falla, Corrado Cescon, Maria Vittoria Raciti, Francesco Tarantino, Lorenzo Preda

Published in: Insights into Imaging | Issue 1/2021

Abstract

Objectives

Changes in mechanical loading as well as pathology can modify the Achilles tendon mechanical properties and therefore detection of these changes is relevant for the diagnosis and management of Achilles tendinopathy. The aim of this study was to evaluate strain and shear wave sonoelastography for their ability to detect changes in the Achilles tendon mechanical properties during a series of isometric contractions.

Methods

Longitudinal sonoelastography images of the Achilles tendon were acquired from 20 healthy participants using four different ultrasound devices; two implementing strain sonoelastography technology (SE1, SE2) and two, shear wave elastography technology (SWE1, SWE2).

Results

SE1 measured a decreasing strain ratio (tendon become harder) during the different contraction levels from 1.51 (0.92) to 0.33 (0.16) whereas SE2 mesaured a decreasing strain ratio from 1.08 (0.76) to 0.50 (0.32). SWE1 measured decreasing tendon stiffness during contractions of increasing intensity from 33.40 (19.61) to 16.19 (2.68) whereas SWE2 revealed increasing tendon stiffness between the first two contraction levels from 428.65 (131.5) kPa to 487.9 (121.5) kPa followed by decreasing stiffness for the higher contraction levels from 459.35 (113.48) kPa to 293.5 (91.18) kPa.

Conclusions

Strain elastography used with a reference material was able to detect elasticity changes between the different contraction levels whereas shear wave elastography was less able to detect changes in Achilles tendon stiffness when under load. Inconsistent results between the two technologies should be further investigated.

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Maffulli N, Sharma P, Luscombe KL (2004) Achilles tendinopathy: aetiology and management. J R Soc Med 97(10):472–476. https://doi.org/10.1258/jrsm.97.10.472CrossRefPubMedPubMedCentral

Magnusson SP, Kjaer M (2018) The impact of loading, unloading, ageing and injury on the human tendon. J Physiol. https://doi.org/10.1113/JP275450CrossRefPubMedPubMedCentral

Obst SJ, Heales LJ, Schrader BL, Davis SA, Dodd KA, Holzberger CJ et al (2018) Are the mechanical or material properties of the Achilles and patellar tendons altered in tendinopathy? A systematic review with meta-analysis. Sports Med 48(9):2179–2198. https://doi.org/10.1007/s40279-018-0956-7CrossRefPubMed

Maffulli N, Almekinders L (2007) The Achilles tendon. Springer, London

Aubry S, Risson JR, Kastler A, Barbier-Brion B, Siliman G, Runge M et al (2013) Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography. Skeletal Radiol 42(8):1143–1150. https://doi.org/10.1007/s00256-013-1649-9CrossRefPubMed

Bercoff J, Tanter M, Fink M (2004) Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control 51(4):396–409CrossRef

De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS (2009) Real-time sonoelastography findings in healthy Achilles tendons. AJR Am J Roentgenol 193(2):W134–W138. https://doi.org/10.2214/AJR.08.1843CrossRefPubMed

DeWall RJ, Slane LC, Lee KS, Thelen DG (2014) Spatial variations in Achilles tendon shear wave speed. J Biomech 47(11):2685–2692. https://doi.org/10.1016/j.jbiomech.2014.05.008CrossRefPubMedPubMedCentral

Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X (1991) Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging 13(2):111–134. https://doi.org/10.1177/016173469101300201CrossRefPubMed

10.

Yanagisawa O, Niitsu M, Kurihara T, Fukubayashi T (2011) Evaluation of human muscle hardness after dynamic exercise with ultrasound real-time tissue elastography: a feasibility study. Clin Radiol 66(9):815–819. https://doi.org/10.1016/j.crad.2011.03.012CrossRefPubMed

11.

Drakonaki EE, Allen GM, Wilson DJ (2012) Ultrasound elastography for musculoskeletal applications. Br J Radiol 85(1019):1435–1445. https://doi.org/10.1259/bjr/93042867CrossRefPubMedPubMedCentral

12.

Schneebeli A, Del Grande F, Vincenzo G, Cescon C, Clijsen R, Biordi F et al (2016) Real-time sonoelastography using an external reference material: test–retest reliability of healthy Achilles tendons. Skeletal Radiol 45(8):1045–1052. https://doi.org/10.1007/s00256-016-2382-yCrossRefPubMed

13.

Yamamoto Y, Yamaguchi S, Sasho T, Fukawa T, Akatsu Y, Nagashima K et al (2016) Quantitative ultrasound elastography with an acoustic coupler for Achilles tendon elasticity: measurement repeatability and normative values. J Ultrasound Med 35(1):159–166. https://doi.org/10.7863/ultra.14.11042CrossRefPubMed

14.

Sandrin L, Tanter M, Catheline S, Fink M (2002) Shear modulus imaging with 2-D transient elastography. IEEE Trans Ultrason Ferroelectr Freq Control 49(4):426–435. https://doi.org/10.1109/58.996560CrossRefPubMed

15.

De Zordo T, Chhem R, Smekal V, Feuchtner G, Reindl M, Fink C et al (2010) Real-time sonoelastography: findings in patients with symptomatic Achilles tendons and comparison to healthy volunteers. Ultraschall Med 31(4):394–400. https://doi.org/10.1055/s-0028-1109809CrossRefPubMed

16.

Klauser AS, Miyamoto H, Tamegger M, Faschingbauer R, Moriggl B, Klima G et al (2013) Achilles tendon assessed with sonoelastography: histologic agreement. Radiology 267(3):837–842. https://doi.org/10.1148/radiol.13121936CrossRefPubMed

17.

Coombes BK, Tucker K, Vicenzino B, Vuvan V, Mellor R, Heales L et al (2018) Achilles and patellar tendinopathy display opposite changes in elastic properties: a shear wave elastography study. Scand J Med Sci Sports 28(3):1201–1208. https://doi.org/10.1111/sms.12986CrossRefPubMed

18.

Dirrichs T, Quack V, Gatz M, Tingart M, Kuhl CK, Schrading S (2016) Shear wave elastography (SWE) for the evaluation of patients with tendinopathies. Acad Radiol 23(10):1204–1213. https://doi.org/10.1016/j.acra.2016.05.012CrossRefPubMed

19.

Corrigan P, Zellers JA, Balascio P, Silbernagel KG, Cortes DH (2019) Quantification of mechanical properties in healthy Achilles tendon using continuous shear wave elastography: a reliability and validation study. Ultrasound Med Biol 45(7):1574–1585. https://doi.org/10.1016/j.ultrasmedbio.2019.03.015CrossRefPubMedPubMedCentral

20.

Payne C, Webborn N, Watt P, Cercignani M (2017) Poor reproducibility of compression elastography in the Achilles tendon: same day and consecutive day measurements. Skeletal Radiol 46(7):889–895. https://doi.org/10.1007/s00256-017-2629-2CrossRefPubMed

21.

Prado-Costa R, Rebelo J, Monteiro-Barroso J, Preto AS (2018) Ultrasound elastography: compression elastography and shear-wave elastography in the assessment of tendon injury. Insights Imaging 9(5):791–814. https://doi.org/10.1007/s13244-018-0642-1CrossRefPubMedPubMedCentral

22.

Bhatia KS, Cho CC, Tong CS, Lee YY, Yuen EH, Ahuja AT (2012) Shear wave elastography of focal salivary gland lesions: preliminary experience in a routine head and neck US clinic. Eur Radiol 22(5):957–965. https://doi.org/10.1007/s00330-011-2364-3CrossRefPubMed

23.

Bortolotto C, Turpini E, Felisaz P, Fresilli D, Fiorina I, Raciti MV et al (2017) Median nerve evaluation by shear wave elastosonography: impact of “bone-proximity” hardening artifacts and inter-observer agreement. J Ultrasound 20(4):293–299. https://doi.org/10.1007/s40477-017-0267-0CrossRefPubMedPubMedCentral

24.

Schneebeli A, Del Grande F, Falla D, Cescon C, Clijsen R, Barbero M (2019) A novel application of strain sonoelastography can detect changes in Achilles tendon elasticity during isometric contractions of increasing intensity. J Foot Ankle Res 12:30. https://doi.org/10.1186/s13047-019-0342-1CrossRefPubMedPubMedCentral

25.

Muraki T, Ishikawa H, Morise S, Yamamoto N, Sano H, Itoi E et al (2015) Ultrasound elastography-based assessment of the elasticity of the supraspinatus muscle and tendon during muscle contraction. J Shoulder Elbow Surg 24(1):120–126. https://doi.org/10.1016/j.jse.2014.04.012CrossRefPubMed

26.

Minafra P, Bortolotto C, Rampinini E, Calliada F, Monetti G (2017) Quantitative elastosonography of the myotendinous junction: normal behavior and correlation with a standard measurement system during functional Tests. J Ultrasound Med 36(1):141–147. https://doi.org/10.7863/ultra.15.11023CrossRefPubMed

27.

Schneebeli A, Falla D, Clijsen R, Barbero M (2020) Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study. BMJ Open Sport Exerc Med 6(1):e000726. https://doi.org/10.1136/bmjsem-2019-000726CrossRefPubMedPubMedCentral

28.

Aubry S, Nueffer JP, Tanter M, Becce F, Vidal C, Michel F (2015) Viscoelasticity in Achilles tendonopathy: quantitative assessment by using real-time shear-wave elastography. Radiology 274(3):821–829. https://doi.org/10.1148/radiol.14140434CrossRefPubMed

29.

Helfenstein-Didier C, Andrade RJ, Brum J, Hug F, Tanter M, Nordez A et al (2016) In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis. Phys Med Biol 61(6):2485–2496. https://doi.org/10.1088/0031-9155/61/6/2485CrossRefPubMed

30.

Slane LC, Martin J, DeWall R, Thelen D, Lee K (2017) Quantitative ultrasound mapping of regional variations in shear wave speeds of the aging Achilles tendon. Eur Radiol 27(2):474–482. https://doi.org/10.1007/s00330-016-4409-0CrossRefPubMed

31.

Cao W, Sun Y, Liu L, Wang Z, Wu JY, Qiu L et al (2019) A multicenter large-sample shear wave ultrasound elastographic study of the achilles tendon in Chinese adults. J Ultrasound Med 38(5):1191–1200. https://doi.org/10.1002/jum.14797CrossRefPubMed

32.

Chino K, Takahashi H (2015) The association of muscle and tendon elasticity with passive joint stiffness: in vivo measurements using ultrasound shear wave elastography. Clin Biomech 30(10):1230–1235. https://doi.org/10.1016/j.clinbiomech.2015.07.014CrossRef

33.

Siu WL, Chan CH, Lam CH, Lee CM, Ying M (2016) Sonographic evaluation of the effect of long-term exercise on Achilles tendon stiffness using shear wave elastography. J Sci Med Sport 19(11):883–887. https://doi.org/10.1016/j.jsams.2016.02.013CrossRefPubMed

Title: Shear wave and strain sonoelastography for the evaluation of the Achilles tendon during isometric contractions
Authors: Alessandro Schneebeli
Ilaria Fiorina
Chandra Bortolotto
Marco Barbero
Deborah Falla
Corrado Cescon
Maria Vittoria Raciti
Francesco Tarantino
Lorenzo Preda
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Ultrasound
Ultrasound
Published in: Insights into Imaging / Issue 1/2021
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-021-00974-y

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Shear wave and strain sonoelastography for the evaluation of the Achilles tendon during isometric contractions

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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